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Hot Flashes (Menopause-like Symptoms, Flushing)
Julie Schwenka, PharmD, UCSF

Hot Flashes Introduction
Medications Table
Medication Side Effects Table
Other Treatments

Hot Flashes Introduction
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Hot flashes can be a troubling symptom in women who have undergone antiestrogen therapy (tamoxifen or aromatase inhibitors) or in men who have been given androgen deprivation therapies (leuprolide, goserelin or orchiectomy). Hot flashes are an increase in body temperature and can also be accompanied by flushing, sweating, palpitations, anxiety and/or irritability. Estrogen replacement therapy is the most effective therapy for hot flashes but many people cannot take estrogen. Alternative medications that have been proven to decrease the frequency and intensity of hot flashes in cancer patients are listed below (items in bold have been shown to be most efficacious with the least amount of side effects):

Medications Table
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Drug Name Usual Dose Efficacy(%)* Generic Available Approximate Monthly Cost
Megestrol Acetate (Megace®) 20 mg orally twice daily 80 Y $20.00
Clonidine patch (Catapres TTS®)** 0.1mg/24h Apply once weekly 30-50 N $45.00
Belladonna, Phenobarbital, Ergotamine (Bellergal-S®) 1 tablet orally twice daily 75 Y $20.00
Methyldopa (Aldomet®) 250mg-500mg orally twice daily 65 Y $20.00
Venlafaxine (Effexor®) 25-75 mg orally daily 65 N $80.00
Vitamin E 800 units orally daily 25 Y $10.00
Paroxetine (Paxil®) 20mg orally daily 67 N $80.00
Fluoxetine (Prozac®) 20mg orally daily 50 Y $45.00
*Placebo efficacy ranges from 20-40%.
**Patches not available in generic however oral tablets are (0.1mg orally per day).

The medications listed above do not come without side effects. You should discuss with your physician or oncologist all options available to you. The table below will list side effects and some other disease states that should be taken into consideration if you are wanting to take that medication.

Medications Side Effects Table
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Drug name Drug Class Side Effects* Contraindications/Warnings**
Megestrol Acetate (Megace®) Progestin hormone Weight gain, vaginal bleeding, chills, insomnia, depression, hyperglycemia Blood clotting disorders. Monitor blood glucose in diabetics
Clonidine patch (Catapres-TTS®) Antihypertensive Decrease blood pressure, drowsiness, dizziness, decrease libido, depression, dry mouth, nausea, constipation Cerebrovascular disease, low blood pressure, kidney impairment. Do not discontinue abruptly, must be tapered off.
Belladonna, Phenobarbital, Ergotamine (Bellergal-S®) Anticholinergic Drowsiness, dry mouth, dry skin, blurred vision, constipation Glaucoma, liver or kidney impairment, asthma, seizure disorder.
Methyldopa (Aldomet®) Antihypertensive Decreased blood pressure, fever, depression, drowsiness, nightmares, headache, dry mouth and extremity swelling Low blood pressure, liver disease, elderly. Do not take with MAO inhibitors.
Venlafaxine (Effexor®) Antidepressant Sweating, fatigue, dry mouth, trouble sleeping, agitation, drowsiness, increase in blood pressure High blood pressure or seizure disorder. Do not take with MAO inhibitors.
Vitamin E Antioxidant, vitamin supplement Blurred vision, dizziness, flu, nausea, headache are signs overdose Interacts with warfarin therapy.
Paroxetine (Paxil®) Antidepressant Headache, sleepiness, dry mouth and sexual dysfunction Seizures, heart disease, kidney disease and other antidepressants
Fluoxetine (Prozac®) Antidepressant Headache, nervousness, dry mouth, insomnia, nausea and sexual dysfunction Seizures, heart disease, liver disease or other antidepressants

*Most side effects may subside or decrease in severity with continued use.
**Inform your physician if you have any of these conditions or disorders. This medication may not be for you.

Other Treatments
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There have been some reports of good response with the use of Gabapentin (Neurontin®) for hot flashes. The dose ranges from 200mg orally once daily to 400mg orally four times daily. These are just patient reports and studies need to be done for further evaluation. Gabapentin can cause weight gain, drowsiness and nausea.

Many herbal/natural products have been used for the relief of hot flashes. The studies that have been done have been discouraging for cancer patients. Soy phytoestrogens, black cohosh, red clover, ginseng and dong quai have not been found to be any more efficacious than placebo. Some of these herbal products may also have estrogen like effects, so use of these products are not recommended without advice from your physician or oncologist.

There are some non-drug treatments to help decrease hot flash symptoms and to prevent triggering them. Eat frequent and small meals. Avoid trigger foods such as caffeine, cayenne pepper, citrus, hot drinks, tyramine (found in aged cheese and red wine), tomatoes and alcohol. Drink lots of water and suck on ice cubes. Keep a cool environment and take cool baths. Wear comfort clothes that are loose fitting and made of cotton. Most importantly, decrease any stress factors and exercise regularly.

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First appeared August 3, 2003; updated January 29, 2007